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The focus of all good care is to determine need. Long-term care (
LTC) is not an extension of acute care—it is distinctive in its very nature. Because LTCcontinues for prolonged periods, it becomes enmeshed in the very fabric of people’s lives. Screening for LTCis one way in which the federal government and, in particular, a state attempts to eliminate unnecessary or premature placement of older or disabled individuals in nursing homes. There are two types of screening: those for a level of care ( LOC) involving just medical need and those that address additional factors of care need, which assess issues such as mental illness, development disabilities, and intellectual disabilities. The determination of LOCaddresses whether the individual’s care needs meet criteria for a stay in a nursing facility long term. This chapter provides an overview of long-term care screenings and how the Omnibus Budget Reconciliation Act ( OBRA) has and continues to impact this process.
The nature of the facility and workload may often leave the social worker with little time for those long-term stay residents and families. Groups are important in nursing facilities, and they are effective in reaching a number of residents, families, or staff at one time. There are a number of different kinds of groups that can be conducted in nursing facilities. Obviously, there are slightly different processes and modifications for different groups, but there are some primary areas to consider in planning for the group. Social workers can look to mentors within the facility as well as individuals outside the facility for support. This chapter reviews the basics of groups in the nursing facility and also discusses remotivation therapy, which is a five-step technique designed to increase socialization and enhance self-esteem of patients, particularly those who have mental illness, posttraumatic stress, or substance use.
Confidentiality can be loosely defined as the state of keeping something secret or private. Confidence is also the state of feeling sure, assured, or reliance upon another person’s secrecy and fidelity. The nursing home is bound by the resident’s right to expect confidentiality of records during the resident’s stay in the nursing facility. All aspects of resident charts in nursing facilities are confidential. Families are also entitled to confidentiality to the extent that the information relates to the resident. Social workers can help the staff understand their role in upholding confidentiality and the reasons that this is important. Through in-services and role modeling, social workers can provide the staff with support to prevent unnecessary disclosure of private material.
The Omnibus Budget Reconciliation Act (
OBRA) is a piece of legislation that was passed by the U.S. Congress in 1987. Its primary purpose was to improve the quality of care provided by long-term care facilities and to enhance the quality of life of the residents. The regulations outlined by OBRAwere aimed at facilities that participate in Medicare and Medicaid systems of payment; private, nonparticipating nursing facilities have also been influenced by these new regulations to some extent. It is important to note that the passage of OBRAalso included funding for states to implement and regulate the process. This chapter provides an overview of the some of the key points of the legislation. It is relevant for social workers to be very familiar with OBRAand the requirements for nursing facilities because these regulations are a hallmark in resident’s rights and access to quality care.
Social workers need to be sensitive to the ethnic and cultural minorities who both work and live in the nursing facility setting. Knowledge, information, and cultural humility about diverse groups can assist in forming positive, supportive relationships. Cultural humility is a way of viewing the understanding of culture as being more than a simple master of certain beliefs or “facts” about a particular culture. By being sensitive to other cultures, the social worker who uses cultural humility is aware of beliefs, values, and biases that are brought to each resident/family encounter. This self-reflection and self-critique help one maintain humility, an important factor in communicating empathy and interest in the well-being of the resident and family. Social workers are particularly well positioned to help by continue to endeavor to learn, to build partnerships with residents and families, and to respect all differences. Through being aware of their own biases, striving to be culturally sensitive, and utilizing knowledgeable approaches, social workers can promote effective healthcare for diverse populations.
Grounding the role of social work in the nursing home setting is the history of the role. Social work in nursing homes has been largely dependent upon the requirements of the regulatory agencies, the public, and the internal structure of facilities. Continuing educational training for current facility workers can assist in providing important information about nursing home residents’ needs and developing necessary skills. In some facilities, efforts are made to provide untrained social workers with support. These supports can include consultation and supervision by qualified social workers. Advocating for more social work hours and/or alleviation of certain duties (such as writing care plan invitations or arranging the seating in the dining room) can be helpful in managing tasks in a busy facility. This chapter provides an overview of social work in nursing facilities and some of the challenges and opportunities of the role.
As with many other professions throughout the United States, the legal requirements for social work practice are driven by the respect for the client’s need for competent services. The social worker in the nursing facility is responsible for a wide array of services for older adults and those with disabilities. State and federal laws and regulations govern social work functions in the nursing facility. Many states regulate both the social work in nursing facilities as well as the licensure of all social workers. Both the federal government and the individual states have enacted specific laws that govern the general description of the social worker’s qualifications, as well as the range of services to be provided to residents in nursing facilities. This chapter discusses the laws regarding the professional social worker position in nursing facilities.
Both the federal government as well as the states mandate annual surveys. Nursing facilities participating in the rules and regulations of Medicaid (Title XIX) and Medicare (Title XVIII) must conduct surveys as a requirement. Federal Registrar Part 483 outlined and defined the basis and scope of these for participating nursing facilities. Joint Commission on Accreditation of Healthcare Organizations (
JCAHO) accreditation is a separate private, nonprofit entity providing accreditation services to a majority of healthcare provider types. Facilities pay a fee to have JCAHOsurvey and accreditation. Interviews with residents and families, the documentation in charts, and care plans form the basis of the process. Proactively, social workers can maintain their notes and care plans, provide staff in-services on key topics so that they are ready for these annual surveys. It should be remembered that surveys are not used as “teaching” the staff. All staff should be well versed on the rules and regulations regarding care.
Medications play a primary role in the care and treatment of both acute and chronic illness. The purpose of medication is to eliminate or reduce the symptoms of illness, promote healing, and increase the comfort and functionality of an individual. Social workers work in the medical setting of the nursing facility. As part of the healthcare team, social workers evaluate medication efficacy and resident medication compliance. They should be familiar with the common antipsychotic medications: Risperdal, Seroquel, Zyprexa, Invega, Abilify, and Clozaril. By recognizing these drugs and their intended action, social workers will be able to look for a matching diagnosis that may be missing in hospital, home, or other referrals. The social worker can question the referring source about the reason for the medication use, the history of use, and the benefits sought.